Complications After Prostate Biopsy: A Meta-analysis of Transrectal Prostate Biopsy Versus Transperineal Prostate Biopsy
CUA Online Library. Winter M. 06/25/13; 31340; MP-08.10
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Abstract
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Introduction:
Two established techniques of prostate biopsy exist: the more commonly used transrectal (TR) approach and the transperineal (TP) approach. By avoiding traversing the rectum, the TP approach is thought to reduce infectious complications.
Objective:
To conduct a systematic review and meta-analysis to determine if any difference in complication rate exists between TR and TP prostate biopsy.
Methods:
Biomedical databases from 1946 to 2012 in Medline, Embase, and Cochrane Central Register of Controlled Trial were searched, as were conference proceedings for the EAU, AUA, and BAUS over the past 10 years. Studies were included if they were randomised controlled trials comparing TR to TP prostate biopsy. Meta-analysis was performed using a fixed effects model. A summary risk ratio (RR) and its 95% confidence interval were calculated. A RR of less than 1 favoured fewer complications with TR prostate biopsy, whilst a RR of greater than 1 indicated more complications with TR prostate biopsy.
Results:
Four studies were identified with 428 patients undergoing TR prostate biopsy and 422 undergoing TP prostate biopsy. No significant heterogeneity was noted between trials. Reported complications were haematuria (38 TR and 46 TP; RR 0.82 [0.54 - 1.23]), infectious complications (7 TR and 3 TP; RR 2.12 [0.60, 7.49]), urinary retention (9 TR and 4 TP; RR 2.08 [0.68 - 6.31]), rectal bleeding (10 TR and 5 TP; RR 1.76 [0.68 – 4.55]), haematospermia (2 TR and 5 TP; RR 0.49 [0.12 - 1.96]) and vasovagal events (4 TR and 2 TP; RR 1.97 [0.36 - 10.63]). No statistically significant difference was seen between complication rates of TR and TP.
Conclusion:
No statistically significant difference in complications was found between TR and TP prostate biopsy. A trend towards rectal bleeding, infectious complications, urinary retention, and vasovagal events occurring more frequently was seen in the TR approach with haematuria and haematospermia more commonly reported during the TP approach.
Two established techniques of prostate biopsy exist: the more commonly used transrectal (TR) approach and the transperineal (TP) approach. By avoiding traversing the rectum, the TP approach is thought to reduce infectious complications.
Objective:
To conduct a systematic review and meta-analysis to determine if any difference in complication rate exists between TR and TP prostate biopsy.
Methods:
Biomedical databases from 1946 to 2012 in Medline, Embase, and Cochrane Central Register of Controlled Trial were searched, as were conference proceedings for the EAU, AUA, and BAUS over the past 10 years. Studies were included if they were randomised controlled trials comparing TR to TP prostate biopsy. Meta-analysis was performed using a fixed effects model. A summary risk ratio (RR) and its 95% confidence interval were calculated. A RR of less than 1 favoured fewer complications with TR prostate biopsy, whilst a RR of greater than 1 indicated more complications with TR prostate biopsy.
Results:
Four studies were identified with 428 patients undergoing TR prostate biopsy and 422 undergoing TP prostate biopsy. No significant heterogeneity was noted between trials. Reported complications were haematuria (38 TR and 46 TP; RR 0.82 [0.54 - 1.23]), infectious complications (7 TR and 3 TP; RR 2.12 [0.60, 7.49]), urinary retention (9 TR and 4 TP; RR 2.08 [0.68 - 6.31]), rectal bleeding (10 TR and 5 TP; RR 1.76 [0.68 – 4.55]), haematospermia (2 TR and 5 TP; RR 0.49 [0.12 - 1.96]) and vasovagal events (4 TR and 2 TP; RR 1.97 [0.36 - 10.63]). No statistically significant difference was seen between complication rates of TR and TP.
Conclusion:
No statistically significant difference in complications was found between TR and TP prostate biopsy. A trend towards rectal bleeding, infectious complications, urinary retention, and vasovagal events occurring more frequently was seen in the TR approach with haematuria and haematospermia more commonly reported during the TP approach.
Introduction:
Two established techniques of prostate biopsy exist: the more commonly used transrectal (TR) approach and the transperineal (TP) approach. By avoiding traversing the rectum, the TP approach is thought to reduce infectious complications.
Objective:
To conduct a systematic review and meta-analysis to determine if any difference in complication rate exists between TR and TP prostate biopsy.
Methods:
Biomedical databases from 1946 to 2012 in Medline, Embase, and Cochrane Central Register of Controlled Trial were searched, as were conference proceedings for the EAU, AUA, and BAUS over the past 10 years. Studies were included if they were randomised controlled trials comparing TR to TP prostate biopsy. Meta-analysis was performed using a fixed effects model. A summary risk ratio (RR) and its 95% confidence interval were calculated. A RR of less than 1 favoured fewer complications with TR prostate biopsy, whilst a RR of greater than 1 indicated more complications with TR prostate biopsy.
Results:
Four studies were identified with 428 patients undergoing TR prostate biopsy and 422 undergoing TP prostate biopsy. No significant heterogeneity was noted between trials. Reported complications were haematuria (38 TR and 46 TP; RR 0.82 [0.54 - 1.23]), infectious complications (7 TR and 3 TP; RR 2.12 [0.60, 7.49]), urinary retention (9 TR and 4 TP; RR 2.08 [0.68 - 6.31]), rectal bleeding (10 TR and 5 TP; RR 1.76 [0.68 – 4.55]), haematospermia (2 TR and 5 TP; RR 0.49 [0.12 - 1.96]) and vasovagal events (4 TR and 2 TP; RR 1.97 [0.36 - 10.63]). No statistically significant difference was seen between complication rates of TR and TP.
Conclusion:
No statistically significant difference in complications was found between TR and TP prostate biopsy. A trend towards rectal bleeding, infectious complications, urinary retention, and vasovagal events occurring more frequently was seen in the TR approach with haematuria and haematospermia more commonly reported during the TP approach.
Two established techniques of prostate biopsy exist: the more commonly used transrectal (TR) approach and the transperineal (TP) approach. By avoiding traversing the rectum, the TP approach is thought to reduce infectious complications.
Objective:
To conduct a systematic review and meta-analysis to determine if any difference in complication rate exists between TR and TP prostate biopsy.
Methods:
Biomedical databases from 1946 to 2012 in Medline, Embase, and Cochrane Central Register of Controlled Trial were searched, as were conference proceedings for the EAU, AUA, and BAUS over the past 10 years. Studies were included if they were randomised controlled trials comparing TR to TP prostate biopsy. Meta-analysis was performed using a fixed effects model. A summary risk ratio (RR) and its 95% confidence interval were calculated. A RR of less than 1 favoured fewer complications with TR prostate biopsy, whilst a RR of greater than 1 indicated more complications with TR prostate biopsy.
Results:
Four studies were identified with 428 patients undergoing TR prostate biopsy and 422 undergoing TP prostate biopsy. No significant heterogeneity was noted between trials. Reported complications were haematuria (38 TR and 46 TP; RR 0.82 [0.54 - 1.23]), infectious complications (7 TR and 3 TP; RR 2.12 [0.60, 7.49]), urinary retention (9 TR and 4 TP; RR 2.08 [0.68 - 6.31]), rectal bleeding (10 TR and 5 TP; RR 1.76 [0.68 – 4.55]), haematospermia (2 TR and 5 TP; RR 0.49 [0.12 - 1.96]) and vasovagal events (4 TR and 2 TP; RR 1.97 [0.36 - 10.63]). No statistically significant difference was seen between complication rates of TR and TP.
Conclusion:
No statistically significant difference in complications was found between TR and TP prostate biopsy. A trend towards rectal bleeding, infectious complications, urinary retention, and vasovagal events occurring more frequently was seen in the TR approach with haematuria and haematospermia more commonly reported during the TP approach.
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